The Breast ExposedTen years after her groundbreaking book on cancer and the environment, the author reconsiders the link between pollution and breast cancer—and remembers the heroes who brought that connection to light.

Pick any date in 1995, and I can tell you where I was. March 2? June 30? November 13? My 36th birthday? I was at my desk, writing. A salad bowl and a frying pan likely sat on the bed, which is where I ate. Every other surface in my Boston apartment was covered with data.

In 1993, I had come to Harvard University on a fellowship to investigate the links between cancer and the environment. Like Rachel Carson, who toiled in these same fields 40 years earlier, I had become alarmed at the disconnect between the evidence contained in scientific literature (quite a lot) and the evidence presented to the public (very little). I felt that I was called—as a biologist, writer and cancer survivor— to construct a bridge over that breach.

The book that resulted from my year of writing— Living Downstream — was published in 1997. Several of its chapters are devoted to breast cancer. This disease received my special attention not because the evidence for an environmental link was overwhelming. Indeed, the data on environment and breast cancer were maddeningly contradictory. Rather, I looked at breast cancer closely because breast-cancer activists were demanding answers about environmental risk factors.

One of the first to call for an end to the silence around environmental carcinogens was feminist writer Judy Brady. Brady’s 1991 anthology, One in Three: Women with Cancer Confront an Epidemic, became a touchstone for women in the environmental breast cancer movement, as sociologists would later call it. By 1995, Brady was authoring essays that exposed the corporate conflicts of interest within the American Cancer Society and the pink-ribbon campaign for breast-cancer awareness.

At the same time, former New York congresswoman Bella Abzug was hosting public hearings on environmental links to breast cancer. National organizations such as Breast Cancer Action and Breast Cancer Fund were reorienting their work toward cancer prevention, as were a growing consortium of support groups. Their efforts were so
successful that, by 1995, two major studies were under way: the Long Island Breast Cancer Study Project and the Cape Cod Breast Cancer and the Environment Study.

So, 10 years later, where are we?

Let’s look at the science first. Throughout the 1990s, the National Cancer Institute (NCI) issued widely publicized announcements that breast cancer incidence, after decades of trending upward, was leveling off. The public was reassured that we were turning the corner on breast cancer at last. Now we know that this assurance was false. In a 2002 paper, NCI researchers reported that the accuracy of its cancer registry data had been compromised by significant delays in the reporting of new cancer cases. Once these delays were corrected, the trend looked much different. Breast cancer rates are still rising,at about 0.6 percent a year.

Or, as Barbara Brenner, executive director of Breast Cancer Action, expresses this rate change, “Ten years ago, I would say a woman in the U.S. was getting diagnosed with breast cancer every three minutes. Now it’s every 1.9 minutes.”

Less clarifying were the long-awaited results of the Long Island and Cape Cod studies. In both locations, researchers found no overall associations between risk of breast cancer and chemical exposures. Researchers did find an increased risk for breast cancer among Long Island women living near hazardous-waste sites that contained pesticides. They also found an increased chance of cancer recurrence in women whose blood showed high levels of PCBs (polychlorinated biphenyls, a mixture of toxic chemicals no longer manufactured in the U.S. but still present in the environment). Cape Cod researchers found that air samples and house dust collected from Cape homes contained dozens of suspected breast carcinogens.

In short, the provocative yet maddeningly contradictory studies I described 10 years ago in Living Downstream have been joined by more provocative yet maddeningly
contradictory studies.

The path through the thicket of uncertainty may lie in a better understanding of the timing of exposure. Just because there is no apparent connection between breast cancer and chemical exposure at the time of diagnosis does not mean there is not a profound connection earlier in life. Studies of lab animals show increased rates of breast cancer among those exposed in utero to trace amounts of dioxin. Prenatal exposure can subtly alter mammary architecture in ways that predispose animals to breast cancer in adulthood. With results like these in mind, the National Institute for Environmental Health Sciences and the National Cancer Institute have established four Breast Cancer and Environment Research Centers to study the early-life exposures that may predispose women to breast cancer.

And what of the activists who set the scientists walking down this path of inquiry? Bella Abzug is gone, as are Andrea Martin, founder of the Breast Cancer Fund, and Susan Claymon and Elenore Pred, founders of Breast Cancer Action. Judy Brady, 68, recently underwent surgery for bladder cancer, a disease she attributes to the chemotherapy drugs she received for her breast cancer 25 years earlier.

Brady’s previous work—outing industries that contribute to breast cancer charities even as they sell or manufacture toxic substances—has been taken up in earnest by Breast Cancer Action in its “think before you pink” campaign. Barbara Brenner, 53, has built alliances with environmental justice groups that are taking on corporate polluters. Brenner says, “We serve no purpose in being nice.”

Breast Cancer Fund now works exclusively on the environment. It is an active partner in the Collaborative on Health and the Environment, which provides the best clearinghouse of information available on environmental links to human disease. Under the direction of health science consultant Nancy Evans, 67, Breast Cancer Fund (together with Breast Cancer Action) has published a critical white paper, “State of the Evidence: What is the Connection Between the Environment and Breast Cancer?,” which will be released in its fourth edition this October.

On the East Coast, the Cambridge-based Women’s Community Cancer Project is rebuilding from the loss of several of its members to breast and brain cancers. Guided by the wisdom of biologist and feminist Rita Arditti, 70, the group works closely with the Alliance for a Healthy Tomorrow in advocating toxics-use reduction. Cornell’s Program on Breast Cancer and Environmental Risk Factors now publishes the best analyses of pesticides and their link to breast cancer, while the Huntington Breast Cancer Action Coalition of Long Island works to turn that scientific evidence into social change. One of its centerpiece projects is the elimination of toxic lawn chemicals.

I recently ran into the latter group’s president, Karen Miller, at a conference on learning disabilities. Laura Weinberg, another radical breast-cancer activist, was also in attendance. Both are now interested in the effects of environmental exposures on girls. The early-life exposures that lead to learning disabilities may also hold clues for breast cancer, they explained. As the mother of a 6-year-daughter myself— and thus no longer having the luxury of chaining myself to a desk for a year—I agreed.

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Sandra Steingraber, Ph.D., is a Distinguished Visiting Scholar at Ithaca
College. Her most recent book is Having Faith: An Ecologist’s Journey to Motherhood (Berkley, 2003).